Health Care Utilization Review Coordinator - UI Health Compliance - UI Health Compliance

Details

Posted: 30-Dec-23

Location: Chicago, Illinois

Type: Full-time

Salary: Open

Categories:

Academic/Faculty
Healthcare Administration

Internal Number: 4899701

Health Care Utilization Review Coordinator - UI Health Compliance - UI Health Compliance
Health Care Utilization Review Coordinator - UI Health Compliance - UI Health Compliance
Hiring Department: UI Health Compliance
Location: Chicago, IL USA
Requisition ID: 1022892
FTE : 1
Work Schedule -
Shift : Days
# of Position: 1
Posting Date: 12/29/2023
This position requires Illinois residency within 180 days of the hire date.
About the University of Illinois Chicago
UIC is among the nation's preeminent urban public research universities, a Carnegie RU/VH research institution, and the largest university in Chicago. UIC serves over 34,000 students, comprising one of the most diverse student bodies in the nation and is designated as a Minority Serving Institution (MSI), an Asian American and Native American Pacific Islander Serving Institution (AANAPSI) and a Hispanic Serving Institution (HSI). Through its 16 colleges, UIC produces nationally and internationally recognized multidisciplinary academic programs in concert with civic, corporate and community partners worldwide, including a full complement of health sciences colleges. By emphasizing cutting-edge and transformational research along with a commitment to the success of all students, UIC embodies the dynamic, vibrant and engaged urban university. Recent 'Best Colleges' rankings published by U.S. News & World Report, found UIC climbed up in its rankings among top public schools in the nation and among all national universities. UIC has nearly 260,000 alumni, and is one of the largest employers in the city of Chicago.
Description:
Position Summary
Serves as an organizational resource on matters relating to clinical documentation and related regulations and guidelines. Responsible for performing compliance auditing, monitoring, and reviews of various hospital services in accordance with the compliance annual plan or as needed. Partners with operational areas in addressing discovered deficiencies. Coordinates process improvement activities and recommends necessary controls to prevent non-compliance.
Duties & Responsibilities

Assists the Director of Reimbursement Compliance in developing and maintaining an annual compliance audit plan and audit workflow

Researches all relevant regulations, policies, procedures, and other standards such as National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), Conditions of Participation, or other CMS policies for audits as necessary

Performs documentation, reviews of records to determine compliance with relevant regulations and guidelines

Documents findings or outcomes and communicates results as directed by Director of Reimbursement Compliance; provides an analysis of findings and recommendations with each report

Provide education to the organization as needed based on the results of audits and reviews

Assists in developing policies and procedures on documentation, and clinical compliance process improvement

Serves as an organizational resource on matters relating to clinical documentation, and medical necessity

Monitors existing and emerging compliance issues and trends

Assist the Director of Reimbursement Compliance in evaluating the adequacy and effectiveness of internal controls for compliance with the requirements of Federal healthcare programs

Prepares summaries and reports for the Compliance Department, clinical departments, compliance committees, and other appropriate groups regarding the results of the reviews and the status of corrective action plans

Performs special projects, or process improvement initiatives based on identified risk areas or targeted audits (e.g., OIG work plan, RAC reviews, or research billing).

Maintains professional competency through continuing professional education and staying abreast of regulatory changes.

Possess a demonstrated knowledge of clinical processes, clinical coding, revenue codes, status indicators, charge processes, and audits.

Qualifications:
Minimum Qualifications

Professional:
A minimum of one year of experience in clinical documentation review or auditing

Graduation from an accredited professional nursing program

Current licensure as a Registered Professional Nurse with the Illinois Department of Financial and Professional Regulation, Division of Professional Regulation.

Five years (60 months) of RN experience.

Current AHA BLS/CPR and other required unit specific certifications

Effective communication skills (oral and written) that facilitate therapeutic relationships between patients, family, and health care providers

Intermediate computer skills with the ability to become proficient in the Electronic Health Record (EHR) with on-the-job training

Excellent attendance, interpersonal skills and work history required.

Preferred Qualifications
Allied health degree with 2 year of experience as a Certified Clinical Documentation Specialist
Preferred Qualifications
-Compliance audit or internal audit experience
Licenses/Certifications:
Certified Clinical Documentation Specialist (CCD)
Certified Professional Medical Auditor (CPMA)
Certified Professional Coder (CPC) or other AAPC
Other certifications offered through HCCA, AAPC, or AHIMA
The University of Illinois System is an equal opportunity employer, including but not limited to disability and/or veteran status, and complies with all applicable state and federal employment mandates. Please visit Required Employment Notices and Posters to view our non-discrimination statement and find additional information about required background checks, sexual harassment/misconduct disclosures, COVID-19 vaccination requirement, and employment eligibility review through E-Verify.
The university provides accommodations to applicants and employees. Request an Accommodation
Looking for more University of Illinois positions?
We invite you to search for positions at each of the University of Illinois locations, the University of Illinois System Office and the University of Illinois Foundation. The University of Illinois System Office supports the primary missions of teaching, research, public service, and economic development for all of the Universities and offers positions in all locations. The University of Illinois Foundation is the official fundraising and private gift-receiving agency for the University of Illinois and also offers position in all locations. Click the links below to search for other University of Illinois positions.
University of Illinois Urbana-Champaign
University of Illinois Springfield
University of Illinois System Office
University of Illinois Foundation
The University of Illinois System is an equal opportunity employer, including but not limited to disability and/or veteran status, and complies with all applicable state and federal employment mandates. Please visit Required Employment Notices and Posters to view our non-discrimination statement and find additional information about required background checks, sexual harassment/misconduct disclosures, COVID-19 vaccination requirement, and employment eligibility review through E-Verify.
To apply, visit https://uic.csod.com/ux/ats/careersite/1/home/requisition/8114?c=uic
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About University of Illinois - Chicago
The University of Illinois Chicago is the city’s largest university and its only public Carnegie Research 1 institution. Its 16 academic colleges serve close to 34,000 undergraduate, graduate and professional students. UIC is recognized as one of the best public universities and one of the most ethnically rich and culturally diverse campuses in the nation, located in the heart of Chicago, it is an integral part of the city's educational, technological and cultural fabric.
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